Bottom Line:
Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today's hyaluronic acid products.Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 microm to less than 1% "by the number." Minor technique-related side effects, however, may occur during the initial learning curve.Patient and physician satisfaction with ArteFill has been shown to be greater than 90%.

Affiliation: Division of Plastic Surgery, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA. glemperle@aol.com

ABSTRACTPatients ask for procedures with long-lasting effects. ArteFill is the first permanent injectable approved in 2006 by the FDA for nasolabial folds. It consists of cleaned microspheres of polymethylmethacrylate (PMMA) suspended in bovine collagen. Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today's hyaluronic acid products. A 5-year follow-up study in U.S. clinical trial patients has shown the same wrinkle improvement as seen at 6 months. Long-term follow-up in European Artecoll patients has shown successful wrinkle correction lasting up to 15 years. A wide variety of off-label indications and applications have been developed that help the physician meet the individual needs of his/her patients. Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 microm to less than 1% "by the number." Minor technique-related side effects, however, may occur during the initial learning curve. Patient and physician satisfaction with ArteFill has been shown to be greater than 90%.

Fig25: Treating radial lip lines: Their lower half will disappear after simple injection of a horizontal strand into the “empty pocket” beneath the vermilion border. The upper half is treated with vertical strands

Mentions:
Radial upper-lip lines usually extend from tiny notches in the vermilion border, which cause the lip to appear aged and lipstick to track and smudge. In younger patients with good projection of the white roll, these wrinkles can be treated vertically from above. It has been helpful to inject one unit of botulinum toxin into each radial lip line 2 weeks before ArteFill treatment. This pretreatment prevents pouting for several weeks. In patients with more than four lines, a better result seems to be achieved by injecting transversely across the entire white roll (Fig. 18). This often prevents further wrinkling and causes the disappearance of the lower half of fine radial lip lines (Fig. 25). A piece of horizontal tape should be worn for 2–3 days to prevent pouting, otherwise nodules may be produced (Fig. 26).Fig. 25

Fig25: Treating radial lip lines: Their lower half will disappear after simple injection of a horizontal strand into the “empty pocket” beneath the vermilion border. The upper half is treated with vertical strands

Mentions:
Radial upper-lip lines usually extend from tiny notches in the vermilion border, which cause the lip to appear aged and lipstick to track and smudge. In younger patients with good projection of the white roll, these wrinkles can be treated vertically from above. It has been helpful to inject one unit of botulinum toxin into each radial lip line 2 weeks before ArteFill treatment. This pretreatment prevents pouting for several weeks. In patients with more than four lines, a better result seems to be achieved by injecting transversely across the entire white roll (Fig. 18). This often prevents further wrinkling and causes the disappearance of the lower half of fine radial lip lines (Fig. 25). A piece of horizontal tape should be worn for 2–3 days to prevent pouting, otherwise nodules may be produced (Fig. 26).Fig. 25

Bottom Line:
Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today's hyaluronic acid products.Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 microm to less than 1% "by the number." Minor technique-related side effects, however, may occur during the initial learning curve.Patient and physician satisfaction with ArteFill has been shown to be greater than 90%.

Affiliation:
Division of Plastic Surgery, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103, USA. glemperle@aol.com

ABSTRACTPatients ask for procedures with long-lasting effects. ArteFill is the first permanent injectable approved in 2006 by the FDA for nasolabial folds. It consists of cleaned microspheres of polymethylmethacrylate (PMMA) suspended in bovine collagen. Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today's hyaluronic acid products. A 5-year follow-up study in U.S. clinical trial patients has shown the same wrinkle improvement as seen at 6 months. Long-term follow-up in European Artecoll patients has shown successful wrinkle correction lasting up to 15 years. A wide variety of off-label indications and applications have been developed that help the physician meet the individual needs of his/her patients. Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 microm to less than 1% "by the number." Minor technique-related side effects, however, may occur during the initial learning curve. Patient and physician satisfaction with ArteFill has been shown to be greater than 90%.